Understanding therapists' perceived determinants of trauma narrative use

Hannah E Frank; Briana S Last; Reem AlRabiah; Jessica Fishman; Brittany N Rudd; Hilary E Kratz; Colleen Harker; Sara Fernandez-Marcote; Kamilah Jackson; Carrie Comeau; Sosunmolu Shoyinka; Rinad S Beidas

doi:10.1186/s43058-021-00231-9

Understanding therapists' perceived determinants of trauma narrative use

Implement Sci Commun. 2021 Dec 2;2(1):131. doi: 10.1186/s43058-021-00231-9.

Authors

Hannah E Frank^{1

2}, Briana S Last³, Reem AlRabiah⁴, Jessica Fishman^{4

5

6}, Brittany N Rudd^{4

7}, Hilary E Kratz⁸, Colleen Harker⁴, Sara Fernandez-Marcote⁹, Kamilah Jackson^{10

11}, Carrie Comeau⁹, Sosunmolu Shoyinka¹⁰, Rinad S Beidas^{4

6

12

13

14}

Affiliations

¹ Department of Psychology, Temple University, Philadelphia, PA, USA. Hannah_Frank@brown.edu.
² Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA. Hannah_Frank@brown.edu.
³ Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
⁵ Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA.
⁶ Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA.
⁷ Department of Psychiatry, University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
⁸ Department of Psychology, La Salle University, Philadelphia, PA, USA.
⁹ Community Behavioral Health, Philadelphia, PA, USA.
¹⁰ Department of Behavioral Health and Intellectual Disability Services, Philadelphia, PA, USA.
¹¹ PerformCare New Jersey, Robbinsville, NJ, USA.
¹² Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
¹³ Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
¹⁴ Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, USA.

Abstract

Background: Trauma narratives are a critical, exposure-based component of trauma-focused cognitive-behavioral therapy, yet community therapists rarely use them. Given evidence that intentions to deliver elements of cognitive behavioral therapy vary by component, and that intentions to deliver exposure are the weakest, this study focused specifically on trauma narratives. We drew on a social psychology causal theory (Theory of Planned Behavior (TPB)) and an implementation science framework (the Consolidated Framework for Implementation Research (CFIR)) to glean insight into multilevel influences on trauma narrative use. While the CFIR offers a broad list of factors potentially affecting implementation, the TPB offers causal pathways between individual-level constructs that predict behavior, including the uptake of an evidence-based intervention. The integration of these approaches may provide a more complete understanding of factors affecting therapists' use of TNs.

Methods: Therapists (n=65) trained in trauma-focused cognitive behavioral therapy completed a survey about their use of and beliefs about trauma narratives. Content analysis was used to identify common beliefs about trauma narratives. A subset of participants (n=17) completed follow-up qualitative interviews, which were analyzed using an integrated approach informed by the CFIR.

Results: While most participants reported high intentions to use TNs, nearly half reported that they did not use TNs in the last 6 months. Survey data indicate a number of TPB-related determinants related to using trauma narratives. Qualitative interviews identified CFIR-relevant contextual factors that may influence constructs central to TPB.

Conclusions: These results highlight the importance of integrating approaches that address multiple theoretical determinants of therapist behavior, including therapist, organizational, and client factors with causal explanations to explain implementation behavior.

Keywords: Consolidated Framework for Implementation Research; Determinants; Implementation science; Theory of Planned Behavior; Trauma-focused cognitive behavioral therapy.

Abstract

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